A coalition of Alabama’s most powerful business and insurance groups is sounding the alarm over a surge in healthcare mandate legislation this session, warning lawmakers that the cumulative cost of the bills will land squarely on employers and families already struggling with rising insurance premiums.
Blue Cross and Blue Shield of Alabama, the Business Council of Alabama, the Alabama Farmers Federation, and the National Federation of Independent Business are among the groups aligning on a unified message to legislative leadership: mandates cost money, and those costs get passed on.
The comments were made in statements to Alabama Daily News’ subscriber newsletter, “Inside Alabama Politics.”
“Since 2024, at least thirty healthcare mandates — measures dictating coverages or reimbursement amounts or costs — have been introduced in the Alabama Legislature,” Blue Cross told IAP. “While some may add less costs than others, the cumulative impact is significant, particularly in an environment where the price of services is increasing every year.”
The Business Council of Alabama echoed those concerns, telling the outlet that mandate proposals “increase costs for employers of all sizes, particularly small and mid-sized businesses, and ultimately impact hardworking Alabamians through higher premiums.”
The Alabama Farmers Federation, which last session won passage of legislation allowing it to sell health coverage plans outside of traditional insurance regulation as a lower-cost alternative, said eleven new healthcare mandates have already been introduced this session that would drive up the cost of those plans.
“Conservative estimates show the cumulative cost of these mandates will be hundreds of dollars a year for families who don’t have employer-sponsored or federally subsidized health coverage — the very people who are already paying the most,” federation external affairs director Brian Hardin said.
The National Federation of Independent Business warned that business owners facing higher premiums have three options, all of them bad.
“They absorb the cost, they pass it on to their employees, or they just stop offering insurance altogether,” Alabama NFIB director Rosemary Elebash told IAP. A recent NFIB report found the number of businesses with 50 or fewer employees offering insurance dropped 44 percent between 2014 and 2023.
The concerns mirror warnings raised earlier this session by House general fund budget Chairman Rex Reynolds (R-Huntsville) and Senate Chairman Greg Albritton (R-Atmore), who flagged the accumulation of mandate bills as a growing fiscal pressure on the state budget.
The tension is playing out most visibly around HB400, an ambulance reimbursement bill sponsored by Rep. Ed Oliver (R-Dadeville) that would require insurers to reimburse ambulance providers at a set percentage of the federal Medicare rate and establish coverage for treatment without transport. Supporters say Alabama’s EMS system is in crisis.
“Ambulance service simply isn’t going to exist if we don’t do this,” Oliver told Alabama Daily News. “The challenge is, when the free market fails, it’s incumbent upon the government to figure out what to do.”
At a House committee hearing last month, Steven Wilson, director of operations for Haynes Ambulance Service in Montgomery, said the bill is critical for rural communities.
“This will help with our rural health care crisis,” Wilson told IAP. “We are grossly underpaid in EMS. Our providers out there don’t make competitive wages.”
But State Rep. Arnold Mooney (R-Birmingham), a 12-year House veteran, said the volume of mandate bills this session is unlike anything he has seen.
“We have had more mandate bills come through in 13 days than I can remember any time in the 12 years I’ve been serving,” Mooney told IAP. “This is going to increase their health care costs. Fundamentally, it cannot not increase them.”
Not all mandate bills have drawn opposition. The Legislature recently sent Gov. Kay Ivey bills requiring insurers to cover breast cancer screenings and prostate cancer screenings without cost-sharing from patients. Blue Cross said it did not oppose either measure because they mirror its existing coverage.
Senate Majority Leader Steve Livingston (R-Scottsboro), whose wife died of lung cancer in 2014 and whose sister died of pancreatic cancer last year, spent three years passing his prostate cancer screening bill and argues the math favors early detection.
“Screenings help, there’s no doubt about it,” Livingston told the outlet. “And they’ll save the insurance companies money in the long run.”
More than 2.75 million Alabama workers and their families rely on employer-sponsored health coverage, according to the Alabama Alliance of Healthcare Consumers.
“The legislature must begin to recognize that the solution to rising health care costs for Alabamians is not to add more costs to employer benefit plans,” alliance executive director Robin Stone told IAP. “Employers need relief, not additional, permanent costs.”
Sawyer Knowles is a capitol reporter for Yellowhammer News. You may contact him at [email protected].
